A patient arrives complaining of flu-like symptoms after a trip to Indonesia. Within days, one patient becomes several as the virus begins to slowly, insidiously make its way through the region.

DAN GLEITER, The Patriot-NewsDoctors take part in a pandemic influenza simulation in the LionReach mobile training center during the Pennsylvania Academy of Family Physicians conference at The Hotel Hershey. The hospital incident commander group includes, from left, nurse practitioner Deborah Moyers, of Lititz, and family physicians, Barbara Majeroni, of State College, Nicole Davis, of Philadelphia, Jane Zendarski, of Bryn Mawr and Claire Murphy, of Reading.
03/09/2012

By the time the size of the outbreak becomes apparent, it is essentially too late to stop. Medical practitioners can only try to limit the scope of the infection and fatalities.

It sounds like the setup for a movie, maybe last year’s “Contagion.”

Instead, it’s a computer-modeled simulation of what could happen if a flu pandemic were to occur in the midstate. Run by Penn State Milton S. Hershey Medical Center, the simulator puts doctors on the spot, forcing them to make health care decisions that determine how far the flu spreads.

The doctors were tasked to make decisions on behalf of a hospital in caring for the influx of sick people. The system then takes their decisions, and, based upon its modeling, figures out the outcome.

“It’s stressful, it’s realistic. Kind of scary,” said Chris Lupold, a physician in Lancaster, who on Friday was playing the role of a hospital administrator. “These types of scenarios ... they’re really interesting and really make you think about it.”

Set over an eight-week period, the simulation compresses time, bombarding the doctors with information and “news alerts” that occur via loud video updates on wall-mounted televisions.

In some cases, the updates parallel the doctors’ decisions. Close schools in the second week and the television anchor appears, announcing the decision.

Or choose not to release the hospital’s small stockpile of anti-viral medication to the public and the news anchor pops back up, announcing people are protesting to demand access to the drugs.

The scoreboard is measured in cold, hard numbers.

The number of people infected.

The number of people who have died.

There are no right answers. The system is designed to fail, and fail it does. The only question is how bad it fails, said Nancy Flint, the program’s coordinator.

Flint operates the program on behalf of the Hershey Medical Center, which post-Katrina received grant funds to study large-population medical emergencies. What they found wasn’t pretty.

Resources quickly run out. Communication quickly breaks down.

For an industry in which money is tight and costs are high, there’s little financial sense in stockpiling resources. A normal flu season, even a mild one, can stretch a small family doctor’s practice or even a larger hospital thin.

“Even at a nonpandemic level, we struggle with [resources] daily,” Lupold said. “We talk about [preparing for this kind of thing], but implementing it is the hard part.”

Flint’s department also found that while other emergency officials — firefighters, emergency medical technicians and police — are trained to deal with mass-casualty situations, the health care field at the micro level isn’t.

Hence the training simulator, which try to mimic a worst case scenario as accurately and realistically as possible.

Decisions are not made in a vacuum. As the doctors debate hospital staffing and the dispersal of drugs, society around the fictitious medical center begins to breakdown.

The weather causes power outages, state police staffing plummets as officers call in sick, schools close and in Scranton, the “police chief” tells residents, “Not to worry, we still have control of the streets.”

The goal is to get doctors — many of whom are primary family care physicians — talking about how they would react to a mass outbreak.

It’s an event that, despite scares, hasn’t really happened in any of their lifetimes. But there are cautionary tales in our history.

In 1918, a strain of the flu killed roughly 3 percent of the world’s population. In the 1950s, another strain took the lives of roughly 70,000 Americans.

On Friday, Lupold’s class did fairly well, considering.

As the simulation rolled on, the number of deaths quickly crossed 1,000, then kept climbing. As communications failed, drug stockpiles dwindled and the hospital ran out of room, the numbers crossed 5,000, then 6,000.

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